Background: High rates of iron-deficiency anemia among school-age children have been a common issue in developing countries. In 2012, China rolled out a school feeding program (SFP) to address this issue. This study assesses changes in anemia rates, as well as potential factors driving these changes, both 3 and 10 years after the SFP was implemented.

Methods: Data were from two cross-sectional surveys (n = 1510) in northwestern China. T-tests were used to compare the differences in health outcomes of students and their dietary diversity across the different sample years. Regressions were used to examine the associations between health outcomes and dietary diversity.

Results: After the SFP was launched, hemoglobin levels of students improved from 126 to 131 g/L between 2015 and 2022/2023; the rates of anemia and stunting decreased from 17% to 6% and 9% to 1%, respectively. A rise in student dietary diversity and an increase in the share of students that consumed iron-rich foods are two main contributing factors.

Implications for School Health Policy, Practice, and Equity: Increase in funding allotted to the SFP over time appears to be a key element in improving the health and nutrition of rural students.

Conclusions: SFP in rural China exemplifies the concrete advantages in improving the health and potential educational outcomes of students.

The massive flow of migrants from rural to urban areas in China over the past decades has sparked concerns about the development of left-behind children. Drawing on a six-round, longitudinal cohort survey in rural China from 2013 to 2023 that follows children from 6 months to 11 years of age, we analyse the effects of two maternal migration patterns – persistent migration (migration without return) and return migration (migration followed by return) – on the cognitive development and nutrition of left-behind children from infancy to early adolescence. The results show that persistent maternal migration has adverse effects on the cognitive development and increased the BMI of left-behind children. In contrast, maternal migration had no significant effect on either cognitive development or any indicator of nutrition when the mother later returned. Persistent maternal migration had a strong, long-term negative effect on the cognitive development of left-behind children especially when mothers migrate within one or one and a half years after childbirth; maternal migration also had a short-term, negative effect on cognitive development when mothers migrate when the child is between 2 and 3 years old. These effects are likely driven by the lower levels of stimulating parenting practices and dietary diversity provided by the stand-in primary caregivers of left-behind children.

The connections between bullying and student well-being in rural areas are not well understood, particularly among younger, more vulnerable students. This study aims to explore the relationship between bullying experiences and the academic performance and mental health of primary and junior high school students in rural China. The sample comprised 1609 students from 30 schools (20 primary schools and 10 junior high schools) in Gansu province. A self-report questionnaire was used to collect data on students’ demographics, bullying experiences, mental health, and social support. Additionally, a 30-minute standardized math test was administered to assess academic performance. Results indicated that bullying was prevalent in rural settings, with 42.64% of students reporting being bullied and 12.74% experiencing it weekly. A significant correlation was found between bullying experiences and both lower academic performance and higher risk of mental health problems, such as depression and anxiety. These correlations became more pronounced with increased frequency of bullying incidents. We also found that female students and younger students who were bullied were more likely to report mental health issues. Furthermore, social support could diminish, but not entirely counteract, the adverse associations between bullying and mental health. These findings highlight the prevalence of bullying among rural students in this age group and demonstrate the associated negative outcomes for their mental health and academic performance. They also emphasize the need for targeted attention and the development of intervention programs, including enhanced school-based anti-bullying initiatives and improved social support systems.

Purpose: Previous research has found an association between with early childhood development (ECD) and paternal beliefs and evidence suggests that paternal beliefs about their own role in child rearing might affect parental involvement. However, there has been no such empirical study in rural China. This study examines the interrelationships among paternal beliefs, parental involvement and ECD among rural Chinese children.

Design/methodology/approach: Data used for this study were collected from 6-to-42-month-old children and their primary caregivers in southwestern China in 2020. ECD was assessed by the Bayley Scales of Infant and Toddler Development-III. Paternal beliefs were assessed with the Role of the Father Questionnaire. The non-parametric regression methods were used to construct the factor scores of ECD. The ordinary least squares models, the mediation models and the bootstrapping approach were employed to investigate the interrelationships of paternal beliefs, parental involvement and ECD.

Findings: A large share of the sample children displayed delays in cognitive, language and social-emotional development. Paternal involvement significantly mediated the link between paternal beliefs and child cognitive and social-emotional development, while maternal involvement mediated the associations between paternal beliefs and child language and social-emotional development.

Originality/value: This study provides a unique contribution by utilizing unique data fathers' beliefs and their involvement in parenting to investigate the underlying mechanisms of how the role of fathers in parenting can lead to the improvement of early child developmental outcomes. This study also provides the first empirical evidence on the role of paternal beliefs in fostering human capital formation during the early stages of life in rural China. This study suggests that shifting paternal beliefs and improving parental involvement are effective pathways to benefit rural children in their early development.

Background: Poor mental health affects caregivers' parenting practices and threatens the early development of children under 2 years old. This study examined the correlations between caregivers' mental health and parenting practices among 5- to 24-month-old children in rural China.

Methods: Data were collected in two cohorts (October 2022 and March 2023) from 948 households randomly sampled from 120 villages. Dependent variable: parenting practices measured by the Family Care Indicators (FCI). Independent variables: caregiver mental health (DASS-21), perceived social support (MSPSS) and socioeconomic status (SES; household asset index, caregiver education). Models adjusted for child age, child sex, caregiver age and household size, with standard errors clustered at the village level.

Results: Although caregivers provided more play materials for their children compared to previous research, the variety of play materials did not improve. Depressive symptoms among caregivers were associated with inadequate parenting practices, particularly with providing a lower variety of play materials. Both lower SES and more severe caregiver depressive symptoms were linked to less stimulating parenting, whereas higher perceived social support was associated with more stimulating practices and partially attenuated these SES- and mental health–related disparities.

Conclusion: Although rural Chinese caregivers now supply more play materials, limited diversity and widespread caregiver mental health risks persist. Strengthening caregiver mental health and social support could enrich home stimulation and improve early childhood development.

China’s urbanization has created growing peri-urban communities, where children face challenges to early childhood development (ECD) despite proximity to developed urban areas. Little is known about how the environmental factors of ECD differ between rural migrants and new urban residents. To address this, we sampled 77 peri-urban households with 18–24-month-old Han Chinese children to examine the associations between early cognitive and language development, parental self-efficacy, stimulating parenting practices, and the home language environment measured with Language Environment Analysis (LENA). We find that rural migrants and new urban residents exhibited no significant difference in any child or household characteristic except parental residency. There was no significant difference in the family environment factors or early cognitive or language development, either. However, parental self-efficacy and stimulating parenting practices both predicted better cognitive and language development in rural migrant households, whereas only conversation turn counts predicted better language development in new urban resident households.

Background
Under-resourced communities in rural China have long faced limitations in accessing and utilising caregiver and child healthcare (CCH). The COVID-19 pandemic exacerbated health inequities globally, while its precise impacts on CCH remain understudied. We report differences in parental migration, maternal mental health, household and nutrition expenditures, child feeding practices, and prenatal, postnatal, and childbirth care following pandemic lockdowns in rural China.

Methods
We compared two groups of families with children who grew to the age of six months either before or during lockdowns. We enrolled eligible households from 80 rural townships, randomly selected from four poverty-designated counties in Sichuan Province, China. We interviewed the control group of primary caregivers in November and December of 2019 (pre-COVID-19), and the case group in May of 2020 (approximately five months into the pandemic). Statistical analyses included t tests and linear regressions with adjustments. P-values <0.05 were considered statistically significant.

Results
Compared to the control group, the case group presented significantly lower paternal migration and more favourable maternal mental health. Caregiving behaviours (including household and nutrition expenditures) and child feeding practices did not differ, except for higher spending on infant micronutrient supplements. Prenatal health services utilisation, including home visits, was slightly higher, while postnatal services utilisation was lower.

Conclusions
Our findings suggest that many aspects of CCH in rural China were similar or improved during the early pandemic lockdowns. These data highlight the importance of promoting targeted public health interventions, such as mental health support initiatives, accessible perinatal care options, and family-centred education campaigns, in under-resourced communities and during future healthcare crises.